10 -Years Coronary Artery Disease Incidence and its Predictors in Overweight and Obese Adults Using A Competing Risk Model: A Longitudinal Study of Yazd Healthy Heart Cohort (YHHC)

We applied competing risk model to identify the predictors for Coronary Artery Disease (CAD) among 866 overweight and obese participants aged 20-74 years using their registered medical records in the first and second phase of Healthy Heart Cohort (YHHC) conducted in Yazd. These participants were free of coronary heart disease in the first phase of study. CAD was considered as the primary event and all other noncardiac deaths were considered as a competing event. The cumulative incidence of any CAD at the 5-year and 10-year follow-ups was approximately 6.8% and 10.6%, respectively, and approximately 4.6% and 8.5%, respectively, for all other noncardiac deaths. In both cause-specific and Fine-Gray models of risk factor diabetes type II, hypertriglyceridemia, university level of education (reversely), uric acid, age, systolic blood pressure and female gender (reversely) were associated with the increase risk of CAD. In addition to other traditional cardio metabolic risk factor we found that uric acid increased the risk of CAD in overweight and obese adults. It seems that lifestyle modification can reduce the risk of CAD. Also, high level of education had a protective effect on the risk of CAD. Both cause-specific and fine-gray models predicted similarly 10-years of CAD. The use of competing risk models in the presence of competing events is emphasized when interpreting survival studies.

Survival Analysis of Age-related Oral Squamous Cell Carcinoma: A Population Study Based on SEER

This research aimed to investigate the prognostic factors of oral squamous cell carcinoma (OSCC), especially the role of age. A total of 33619 cases of OSCC were received from the Surveillance, Epidemiology, and End Results database during 2005–2015. Kaplan-Meier curves of 5-year overall survival rates and 5-year cancer specific survival rates were performed, and univariate and multivariate Cox regression analysis as well as competing risk model were used to help understand the relationship between various factors and mortality of OSCC. Compared to 18–39 years old group, the older age was an important predictor of worse prognosis. The multivariate analysis of overall survival (OS) were 50–59 years old (HR, 1.32; 95% CI, 1.17–1.48; p ≤ .001), 60–69 years old (HR, 1.66; 95% CI, 1.42–1.87; p ≤ .001) and 70 + years old (HR, 3.21; 95% CI, 2.86–3.62; p ≤ .001) respectively, while the specific value of competing risk model were 60–69 years old (HR, 1.21; 95% CI, 1.07–1.38; p = .002) and 70 + years old (HR, 1.85; 95% CI, 1.63–2.10; p ≤ .001). In addition, female gender, unmarried, Blacks, tumor in floor of mouth, size and higher TNM classification were also other predictors that signify significant clinically deterioration of OS / CSS. Our research revealed that age was an important factor in explaining the difference of survival in the whole process of OSCC. It’s suggested that we should pay attention to the influence of age on diagnosis, treatment and prognosis in the clinical process.

Office, Central, and Ambulatory Blood Pressure for Predicting First Stroke in Older Adults: A Community-Based Cohort Study

Hypertension is the most prevalent modifiable risk factor for stroke. Office blood pressure (BP) measurements may have limitations in defining the impact of hypertension on stroke. Our aim was to compare the stroke risk for office, central, and ambulatory BP measurements in a predominantly older population-based prospective cohort. Participants in the CABL study (Cardiovascular Abnormalities and Brain Lesions; n=816; mean age, 70.8±9.0 years; 39.8% men) underwent applanation tonometry of the radial artery for central BP and 24-hour ambulatory BP monitoring. During a follow-up of 9.6±3.1 years, stroke occurred in 76 participants (9.3%). Among office BP variables, only diastolic BP was associated with stroke in multivariable competing risk model ( P =0.016). None of the central BP variables showed a significant association with stroke. Conversely, all ambulatory systolic and diastolic BP variables were significantly associated with stroke after adjustment for clinical confounders (all P <0.005). In an additional multivariable competing risk model including both ambulatory systolic and diastolic BP values obtained at the same time of the day, diastolic BP was more strongly associated with stroke than systolic BP in 24-hour, daytime, and nighttime periods (all P <0.05). Therefore, in a predominantly older population-based cohort, office diastolic BP was weakly associated with incident stroke; no central BP variable was prognostic of stroke. However, all ambulatory systolic and diastolic BP values were significantly associated with stroke in multivariable competing risk analyses. Moreover, ambulatory diastolic BP was a stronger predictor of stroke than ambulatory systolic BP.

Abstract P146: Comparative Effectiveness Of Direct Oral Anticoagulants Versus Warfarin Among Medicare Beneficiaries With Atrial Fibrillation

Objective: Post-hoc analysis of three pivotal clinical trials suggests no difference in risk of ischemic stroke or systemic embolism among cancer patients with atrial fibrillation treated with direct oral anticoagulants (DOACs) vs. warfarin. However, these studies were underpowered and also do not reflect the context of real-world use. We compared the effectiveness of DOACs versus warfarin for the risk of stroke or systemic embolism and all-cause death in patients with NVAF. Methods: We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2009 to 2016 and included patients aged ≥66 years diagnosed with cancer (breast, bladder, colorectal, esophagus, lung, ovary, kidney, pancreas, prostate, stomach or uterus) and NVAF. We limited the cohort to patients who newly initiated warfarin or DOACs (from 2010 to 2016) with no history of ischemic stroke or systemic embolism. The primary outcome was hospitalization due to ischemic stroke or systemic embolism and the secondary outcome was all-cause death. We used Fine and Gray’s competing risk model, while treating death as a competing risk, to determine the association of oral anticoagulants with the incidence of stroke or systemic embolism. We also adjusted the analysis using inverse probability of treatment weighted (IPTW). Additionally, an IPTW-adjusted Cox proportional hazards regression model was constructed for all-cause death. Results: Of 1,028,784 patients with cancer, 158,744 (15.4%) were diagnosed with atrial fibrillation. After applying all inclusion criteria, the final study cohort included 7,334 cancer patients diagnosed with incident NVAF who newly initiated warfarin or DOACs, of which 3,194 (43.6%) used warfarin and 4,140 (56.4%) used DOACs. The unadjusted rate of stroke or systemic embolism was similar among warfarin and DOACs users (1.20 vs. 1.32 cases per 100 person-years, p=0.27). In the IPTW weighted competing risk model, the use of DOACs was not associated with an increased risk of stroke or systemic embolism compared with warfarin users (Hazard Ratio [HR] 1.41, 95% confidence intervals [CI] 0.90-2.20). However, DOACs users had a significantly lower risk of all-cause death compared with warfarin users (HR 0.82, CI 0.74-0.91). Conclusion: Among cancer patients diagnosed with NVAF, DOACs had a similar risk for stroke or systemic embolism compared to warfarin, although DOAC use was associated with reduced risk of all-cause mortality.

Gout as a risk factor for acute myocardial infarction: evidence from competing risk model analysis

Chronic inflammation, a hallmark of gout, is implicated in the pathogenesis of atherosclerosis. Thus, in theory, gout can be expected to increase the risk of acute myocardial infarction (AMI). Yet, results from several epidemiological studies have been inconclusive. A retrospective cohort study was conducted using the National Health Insurance Research Database of Taiwan dated from 2000 to 2013. The study cohort comprised 3581 patients with gout (the gout cohort) and 14,324 patients without gout (the non-gout cohort). The primary outcome was the incidence of AMI. To estimate the effect of gout on the risk of AMI, the Lunn-McNeil competing risk model was fitted to estimate cause-specific hazard ratios (HRs) and their 95% confidence intervals (CIs). The cumulative incidence of AMI was significantly higher in the gout cohort than in the non-gout cohort, resulting in an adjusted HR of 1.36 (95% CI 1.04 to 2.76). Further, HRs of gout with incident AMI were higher in patients without hypertension, diabetes mellitus, or hyperlipidemia (ranging from 1.63 to 2.09) than in those with each of these comorbidities (ranging from 0.95 to 1.13). The results of this study suggest that patients with gout have an increased risk of AMI. The AMI risk associated with gout was conditional on patients’ cardiovascular risk profile. Future work is needed to confirm these findings.